Healthcare for seniors face major labor, payment hurdles


The healthcare industry is facing a wide variety of challenges—and solutions aren’t always straightforward. Each month, Modern Healthcare asks leaders in the field to weigh in on their approaches to the sector’s thorny issues. This week, we hear from Katie Smith Sloan, president and CEO of LeadingAge, and Joel Theisen, founder and CEO at Lifespark, about what’s ahead for the senior care sector.

The number of people age 65 and older in the U.S. is projected to rise from more than 56 million now to over 73 million by 2030. Their care needs will grow along with their numbers.

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What do you consider to be the most critical challenge in the senior care sector right now?

Smith Sloan: That’s an easy one. It’s workforce. workforce, workforce. We have an aging population and growing demand for services, and we simply do not have enough people to fill jobs in our field. This isn’t just a nursing home issue; this is home health, it’s adult day care, it’s assisted living, it’s across the board. And that’s creating significant challenges.

Theisen: At the highest level is the challenge around reimbursement. Everybody talks about value-based care versus fee-for-service. I want to see all the systems and all the system players, all the segments, align around global risk. That’s when the actual dollars filter down, in my opinion, to the clients, the families and the community.

What are some policy changes or proposals that could mitigate the situation?

Smith Sloan: We need an all-government solution here. It’s not just a [Health and Human Services Department] issue. There’s also a State Department angle and a Homeland Security angle, with respect to immigration. There are Departments of Education and Labor angles with respect to training dollars and apprenticeship programs. One of the things we’re pushing hard for is to free up unused visas for nurses that just haven’t been allocated yet.

Theisen: There’s actually been movement on reimbursement policy-wise ever since the Affordable Care Act. I think the reimbursement is there; it has changed. What we have to change now is the delivery system, not the payer system. The government has already said, “Hey, 19% GDP [in healthcare spending] is unsustainable.” The challenge is that at the service level, we have the old guard still negotiating fee-for-service contracts.

Do you believe we’re doing as much as possible to support aging in place and making senior care home-centric?

Smith Sloan: Most people age in their homes and most of the care provided is by family members—who often are giving up a job to take care of an older relative or a loved one. … We have a patchwork of services and support with very different funding sources. And that makes it difficult for people to stay in their home. … Form follows finance, so the gaps, in part, are a function of the way we finance long-term care in this country.

Theisen: Not even close. Financial incentives to create lifelong value for seniors are backwards. They’re too heavily focused on fee-for-service and reward “acute, reactive care” in facilities, versus … in the home and community where seniors thrive. Government efforts to move the market toward more “at-risk” options financially reward home-based value creation, but I would argue adoption isn’t high enough and should be mandated.

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